Systemic sclerosis (SSc) is one of the systemic autoimmune diseases characterized by disease-specific autoantibodies and generalized fibrosis in connective tissues and internal organs, resulting from microvascular and immune dysfunctions, which lead to premature death in affected individuals. The etiology of SSc is complex and poorly understood; however, as with most autoimmune conditions, it is widely accepted that both environmental and genetic factors interact and contribute to disease development.

Over the last decade, genome-wide association studies (GWAS) have identified multiple genetic markers associated with SSc, and a number of causal variants have also been fine-mapped using state-of-the-art statistical techniques. Furthermore, the latest East Asian GWAS identified novel risk variants that were not as strongly represented in Europeans as in East Asians, and also provided additional novel risk variants, highlighting the importance of enrolling a diverse population for the analysis of complex traits. The association of human leukocyte antigen regions has been clarified mainly in individuals of European descent, with the identification of clinical subtype-specific associations of certain alleles. The associations in East Asian SSc are currently being analyzed by our team.

Recent advances in single-cell ribonucleic acid (RNA) sequence technology have enabled the identification of transcriptomic changes at the single-cell level in a cell type or tissue-specific manner, allowing for the identification of disease-relevant cells or transcriptomes. To date, multiple single-cell RNA sequence studies have been conducted, primarily focusing on cells and transcriptomes in peripheral blood, skin, or lung.

Despite the remarkable advances in state-of-the-art technology for both genetics and transcriptomics, gene expression regulations, especially by enhancers, enriched for disease heritability and thus critical for SSc development, remain unresolved. Integrative analysis using multi-omics approaches, combined with deep phenotyping of study cohorts, is imperative to fully characterize the genetic component of this disease and to identify causal variants, which may lead to more targeted and effective treatment of SSc.

Background: The increase in international tourists and residents in Japan has necessitated Japanese medical institutions to extend their services to patients, presenting new challenges such as unpaid medical bills. The treatment of foreign patients is further complicated by linguistic, cultural, and social barriers, which heighten the risk of unpaid bills. This highlights the critical need to examine the issue of unpaid medical bills in the context of foreign patient care in Japan. This study investigates trends in research, the regions most affected, and the impact of unpaid medical expenses on patients and healthcare institutions.

Methods: A scoping review was conducted using articles indexed in MEDLINE, Web of Science, Scopus, CINAHL Plus, Ichushi-Web (Japanese medical literature), and Google Scholar, with a focus on publications from Japan discussing unpaid medical bills with foreign patients.

Results: Seventeen publications met the criteria, highlighting the difficulties in collecting medical expenses from foreign patients. Prevention methods, such as prepayment and presenting estimated costs before care were suggested but had limited success. There are also few policies to assist medical institutions with outstanding expenses from foreign patients.

Conclusions: This study underscores the urgent need for comprehensive strategies to address unpaid medical bills among foreign patients in Japan, emphasizing further research to develop effective interventions and enhance the overall healthcare experience for these patients.

Atherosclerosis, the leading cause of coronary artery disease, stroke, and peripheral arterial disease, is now recognized as a lipid-driven disease complicated by an immune response that plays a major role in its pathogenesis. The response-to-injury hypothesis proposed by Ross et al. laid the foundation for understanding atherosclerosis as a chronic inflammatory process, in which endothelial injury and lipid insudation trigger immune activation, smooth muscle cell proliferation, and plaque formation. Traditional approaches, such as immunohistochemistry, flow cytometry, and bulk RNA sequencing, have identified macrophages and T cells as the key immune players in plaques. However, these methods lack the resolution to differentiate among diverse immune cell states or to detect rare but functionally significant populations. Recent advances in single-cell and spatial transcriptomic technologies have revolutionized our understanding of atherosclerotic plaques. These methods have generated detailed cellular atlases in murine models and human atherosclerotic tissues, revealing previously unrecognized immune cell subsets and novel pathogenic pathways. Single-cell analyses have identified a heterogeneous spectrum of macrophages, including resident-like, inflammatory, and TREM2^high foamy subsets, in addition to a CD163⁺ macrophage subset, including the hemoglobin-stimulated macrophage [M (Hb) ] phenotype. In parallel, functionally diverse T-cell subsets with specialized pro- and anti-inflammatory roles have also been characterized. Spatial transcriptomics has provided further insights into the anatomical organization of these immune populations within plaques, highlighting region-specific inflammatory niches and fibrous-cap dynamics. Furthermore, single-cell T-cell receptor sequencing has identified antigen-specific T-cell expansions, supporting the hypothesis that atherosclerosis exhibits autoimmune-like characteristics. These findings have major therapeutic implications. The selective targeting of specific types of pro-inflammatory macrophages and tailored immunomodulation of T-cell subsets may provide new strategies to stabilize plaques and other novel and targeted immunomodulatory approaches to prevent cardiovascular events. As single-cell and spatial technologies continue to evolve, they will further refine our ability to design precision immunotherapies for atherosclerosis by integrating classical inflammatory models with high-resolution molecular insights.

The triad of blood pressure measurement, urinalysis, and edema assessment has constituted the cornerstone of prenatal care for over eight decades and has been consistently recorded at each examination in Japan's Maternal and Child Health Handbook. Historically, these examinations were prioritized to facilitate the early diagnosis and treatment of pregnancy toxemia-now termed hypertensive disorders of pregnancy-which once represented a leading cause of maternal mortality. The triad has undeniably played a pivotal role in the early diagnosis, prediction, and treatment of hypertensive disorders of pregnancy, while potentially contributing to the detection of other obstetric complications. However, conclusive evidence linking these conventionally performed assessments to actual pregnancy and delivery outcomes remains limited, and critical unresolved issues persist within each examination category. Blood pressure assessment requires the establishment of optimal blood pressure thresholds to achieve favorable pregnancy and perinatal outcomes; to achieve this, home blood pressure monitoring should be adopted. Evidence-based target blood pressure ranges for treatment initiation in hypertensive disorders of pregnancy and therapeutic targets are urgently needed. For urinary protein assessment, the establishment of standardized criteria for postpartum proteinuria follow-up is essential. In terms of edema, critical evidence is lacking regarding the evaluation and treatment of pathological edema that adversely affects pregnancy outcomes. This review traces the historical evolution of these examinations while critically examining their contemporary role in perinatal care. A notable characteristic of this triad is its noninvasive nature and minimal cost burden. The establishment of robust evidence supporting their clinical utility could optimize maternal and fetal outcomes while maintaining cost-effective healthcare delivery.

Advancements in artificial intelligence and sensor-based systems are transforming personalized preventive medicine. This "suggestion review" explores an artificial intelligence (AI) -driven healthcare ecosystem that integrates and analyzes personal health data to ensure transparency and tailored guidance for optimal well-being. AI enables real-time health monitoring, proactive interventions, and emergency response systems, addressing current healthcare limitations. By employing advanced machine learning techniques, AI improves decision-making, stress management, and personalized health recommendations. Additionally, this review explores the economic benefits of AI-driven preventive healthcare, emphasizing cost-effectiveness and improved outcomes. Ethical considerations, data security, and user autonomy are also discussed to ensure the responsible deployment of AI in healthcare.

Cerebral aneurysms are a potentially life-threatening vascular pathology that can lead to subarachnoid hemorrhage, a neurological emergency associated with high morbidity and mortality. Traditional imaging-based assessments (largely centered on aneurysm size, shape, and location) often fall short in accurately predicting rupture risk. This limitation highlights the need for more advanced, individualized diagnostic strategies. Recent advancements in artificial intelligence (AI) have introduced powerful tools capable of transforming cerebrovascular imaging and aneurysm management. This narrative review synthesizes published studies on the application of AI in cerebrovascular imaging, focusing on its potential to aid in aneurysm detection and rupture risk prediction. It examines the evolving role of AI through three primary technological approaches: radiomics, machine learning (ML), and deep learning (DL). Radiomics enables the extraction of quantitative features from imaging data, revealing patterns and morphological indicators that may not be visible to the human eye. ML models synthesize imaging, clinical, and hemodynamic data to predict rupture risk with greater precision than traditional scoring tools. DL techniques, particularly convolutional neural networks, automate aneurysm detection and interpretation directly from raw image data.

What sets this review apart from previous literature is its integrative approach: rather than focusing narrowly on one AI technique or imaging modality, it unifies radiomics, ML, and DL under a single framework and evaluates their clinical applications across both detection and risk prediction. Furthermore, it emphasizes emerging solutions like hybrid modeling, explainable AI, and multimodal data fusion, which are critical for real-world clinical translation. However, current AI-based methods remain at the investigational stage and have not yet been validated clinically, experimentally, or against existing diagnostic standards. Importantly, this review situates AI methods relative to established clinical benchmarks, including radiologist interpretation and risk scores such as PHASES (Population, Hypertension, Age, Size of aneurysm, Earlier subarachnoid, Hypertension, Age, Size of aneurysm, Earlier subarachnoid hemorrhage, and Site of aneurysm) and hemorrhage, and Site of aneurysm) and ELAPSS ( (Earlier subarachnoid hemorrhage Earlier subarachnoid hemorrhage, Location of aneurysm, Age, Population, Size of aneurysm, and Shape of aneurysm), Location of aneurysm, Age, Population, Size of aneurysm, and Shape of aneurysm), and emphasizes that rigorous prospective validation is essential before widespread adoption. It also proposes practical implementation strategies, including decision support integration, standardization protocols, and federated learning to enable secure data collaboration. By addressing both technical innovation and translational challenges, this review offers a clinician-focused roadmap that advances the field beyond theoretical models toward personalized aneurysm care. In doing so, it aims to reduce rupture rates and improve patient outcomes through precision medicine powered by AI.

Introduction: In Japan, suicide is the most common cause of death among women who die in the first year after childbirth. This study aimed to analyze the loneliness of mothers raising infants in central Tokyo and to provide evidence for improving maternal mental health.

Methods: Fieldwork was conducted from June to September 2024, and questionnaire surveys were administered to 104 mothers who visited childcare support groups in Setagaya ward, Tokyo. Survey items were socioeconomic indicators and the Japanese version of the University of California, Los Angeles (UCLA) loneliness Scale Version 3 (UCLA-LS3-J), containing 20 items. Structured equation modeling (SEM) was conducted to analyze differences in loneliness by mother and infant characteristics.

Results: The average age of the mothers was 34.4 years, and that of their youngest child was 9.8 months. Among them, 24.0% of the mothers had a UCLA-LS3-J score >40 (which is considered moderate to high in terms of loneliness). SEM identified three factors independently associated with loneliness: health status, daily use of a nursery school or kindergarten, and the number of people the mothers could consult (p <0.05). Specifically, loneliness of the mothers was significantly higher when they were feeling less healthy, not using a nursery school or kindergarten, and having fewer people that they could consult.

Conclusions: Some mothers felt particularly isolated, and an intervention to strengthen consultation could be effective in improving loneliness of the mothers living in central Tokyo. Moreover, promotion of the use of nursery schools or kindergartens is also expected to improve the mothers' mental health.

Introduction: This study aimed to evaluate the accuracy of screening using the six-item Kessler Psychological Distress Scale (K6) for suicide death after the Great East Japan Earthquake (GEJE) in combination with binge drinking, diagnosed history of mental disorders, disaster-related experiences, disaster stress symptoms, sleep status, and social network, which were used in the practical settings of disaster-related mental health services.

Methods: This prospective cohort study spanned the period from 2013 to 2021. Among the Tohoku Medical Megabank Project sample, 27,335 affected residents and 61,157 residents living within the disaster-stricken area (i.e., those who experienced partial or no house damage and did not evacuate even if they lived in the disaster-stricken area) of the GEJE were analyzed using receiver operating characteristic curve (ROC) analyses of the K6 score in combination with the following related factors: binge drinking, disaster experiences (loss of a family member, relatives and friends, and decrease in income), disaster-related stress symptoms (recollection of disaster experiences, physical reactions due to recalling the disaster), diagnosed history of mental disorders (depression and post-traumatic stress disorder [PTSD]), sleep status, and social network.

Results: In the ROC analyses, when the K6 score was combined with relevant variables, newly developed PTSD after the GEJE (area under the curve [AUC]: 0.878 [95% confidence interval (CI): 0.773-0.982]), disaster-related stress symptom of recollection of disaster experiences (AUC: 0.849 [95% CI: 0.714-0.985]), and decreased income (AUC: 0.835 [95% CI: 0.726-0.945] yielded higher AUCs than did the K6 score alone (AUC: 0.681 [95% CI: 0.567-0.794]).

Conclusions: When screening using K6 for suicide death, combining the K6 score with newly developed PTSD, recollection-related disaster stress symptoms, and decreased income could generate more accurate predictions of suicide after the disaster. We hope these findings will contribute to minimizing post-disaster suicide in the context of disaster-related mental health services. (297 words)

Introduction: We compared the proportion of hospitalizations in patients who received initial telemedicine consultations and in those who received in-person consultations.

Methods: We used the DeSC database, a large administrative claims database for Japan, from April 2020 to November 2022. In this retrospective cohort study, we identified outpatients with respiratory or digestive diseases. The exposure group comprised patients who received an initial telemedicine consultation through the use of telephones and other telecommunication devices. The control group comprised patients who underwent an initial in-person consultation. The outcome measure was hospitalization within 1 month of the index date. Propensity score matching and multilevel logistic regression were performed, with patients at the subject level and medical institutions at the cluster level. A total of 3,026,260 eligible patients were identified. The index date for each patient was defined as the day when the patient was diagnosed with respiratory or digestive diseases at the initial consultation. Respiratory and digestive diseases were defined according to the International Classification of Diseases, 10th Revision codes.

Results: The proportions of hospitalization within 1 month of the index date were 1.0% and 0.5% in the telemedicine and in-person consultation groups, respectively (odds ratio, 2.61; 95% confidence interval, 1.64-4.14; p < 0.001).

Conclusions: Initial telemedicine consultation was significantly associated with an increase in hospitalization when compared with initial in-person consultation.

Introduction: Raising a child with a neurodevelopmental disorder can present significant challenges for families and is a known risk factor for increased parental stress. Successfully addressing these challenges by promoting family functioning is considered crucial, with particular recent emphasis on optimal paternal involvement. Interventions targeting fathers can help foster stronger family relationships, reduce stress, and enhance overall family functioning, which in turn supports the growth and neurodevelopment of the child. The present study examined the impact of fathers' successful childcare behaviors and attitudes on the family, specifically focusing on children with neurodevelopmental disorders.

Methods: An online survey was conducted with couples who had children aged 2 to 12 years diagnosed with or suspected of having a neurodevelopmental disorder. The survey explored the characteristics of fathers considered successful in parenting, assessing their effect on the child's neurodevelopment and the partner's parenting stress. Structural models were then constructed to quantify these relationships.

Results: The survey results indicated that fathers who effectively managed childcare responsibilities indirectly contributed to reducing the child's behavioral problems by significantly alleviating the spouse's parenting stress.

Conclusions: Fathers may play an important role in indirectly mitigating behavioral issues in children with neurodevelopmental disorders. Fostering self-awareness in fathers and helping them build positive relationships with their partners appear to be essential components of effective parenting. These aspects should be incorporated into father training programs to better support family dynamics and, by extension, the growth of children with neurodevelopmental disorders.

Introduction: Most rheumatic diseases are caused by a complex interplay of genetic, physical, and environmental factors. Large-scale disasters affect all of these factors; however, their impact on rheumatic diseases is unknown. We aimed to investigate changes in antirheumatic drug prescriptions among victims and non-victims after the 2018 Japan Flood: the second largest water-related disaster in Japan.

Methods: In this retrospective cohort study, we used data from the Japanese National Database of Health Insurance Claims, which included information on all drugs prescribed by physicians. We included all cases of prescription at medical institutions in disaster-stricken areas between July 2017 and June 2019. The newly initiated prescription of methotrexate (MTX, 2-mg tablets or capsules), which has been exclusively approved for rheumatoid arthritis, juvenile idiopathic arthritis, or psoriatic arthritis/psoriasis in Japan, and other antirheumatic drugs within the first year after the disaster were evaluated for government-certified disaster victims and non-victims. Baseline characteristics and MTX prescription status in the pre-disaster period were also assessed to compare the groups.

Results: In the pre-disaster period, no significant association was found between victim status and MTX prescription. The number of individuals who had not been prescribed MTX before the disaster was 4,973,401, including 31,006 victims. Among them, 14,908 (including 110 victims) had a history of MTX prescription after the disaster. In the MTX-naive group, new MTX prescriptions within one year after the disaster were significantly more frequent in victims than in non-victims (age- and sex-adjusted hazard ratio: 1.83; 95% confidence interval: 1.37-2.46). Similarly, a non-significant increase in prescriptions for conventional synthetic/biological disease-modifying antirheumatic drugs was observed.

Conclusions: Victims of the 2018 Japan Flood were more likely to be prescribed MTX for the first time.

Introduction: Hearing loss is a public concern, considering its high prevalence and negative effects on older adults. Limited data on hearing loss are available from Japan, which has a high aging rate. Hearing loss generally begins bilaterally at high frequencies with age. This study aimed to describe the prevalence, age-standardized prevalence, and incidence rates of bilateral high-frequency hearing loss (HFHL), using data from Japan.

Methods: This descriptive study utilized Ningen Dock and regular health check-up examination data obtained from the Seirei Health Care Division from 2014 to 2020. The outcome was bilateral inaudibility of 40 dB at 4 kHz (bilateral HFHL). The prevalence in each age group in 2020, age-standardized prevalence from 2014 to 2020 using the direct method, and incidence rates (per 1,000 person-years) were calculated by sex.

Results: Most participants (60% male) underwent Ningen Dock. Each year, the number of participants was 55,000-62,500. The mean age of participants was in the early 50s. Both the prevalence and incidence rates of bilateral HFHL increased sharply from the 60s and were higher in males than in females across generations; the prevalence was < 4% in the early 50s, reaching 46.5% and 20.2% in males and females, respectively, in their 70s. Incidence rates were 10.8 and 2.1, respectively, in the 50s, increasing to 106.7 and 43.5, respectively, in the 80s. Age-standardized prevalence slightly decreased from 2014 to 2020 in both sexes.

Conclusions: Both the prevalence and incidence rates of bilateral HFHL increased dramatically from the 60s and were higher in males than in females across generations. Age-standardized prevalence slightly decreased during the study period. This study is valuable because of the limited number of studies on hearing loss in Japan. However, most participants were considered to have high socioeconomic status, and further research targeting Japanese individuals is warranted.

Introduction: Japan's aging population and declining birthrate have intensified the need for foreign workers, with Vietnamese workers now forming the largest group among over 2 million foreign laborers. While statistical studies on their work situations and mental health are increasing, they offer limited direct insight into these workers' lived experiences. This study aimed to capture their firsthand voices, focusing on differences by residency status.

Methods: Open-ended responses from 100 Vietnamese workers in Japan, collected through a 2022 survey, were analyzed. Content analysis was used to categorize experiences into positive and negative aspects.

Results: Positive experiences included job satisfaction, adequate salaries, safe environments, supportive colleagues, and personal growth, with workers particularly valuing learning opportunities and workplace relationships that fostered development. Negative experiences, which were more prevalent, encompassed demanding workloads, unfair treatment, inadequate pay, long hours, and insufficient rest. Cultural and language barriers also hindered workplace relationships. Technical Intern Trainees (TIT) more frequently reported dissatisfaction with wages and conditions, while Engineer/Specialist in Humanities/International Services (ESI) workers more often cited interpersonal challenges linked to cultural adaptation.

Conclusions: Vietnamese workers gain certain benefits from employment in Japan but frequently report dissatisfaction. TIT workers tend to face systemic issues, whereas ESI workers more often experience interpersonal challenges rooted in cultural differences. Addressing both types of challenges with consideration for the distinct situations of foreign workers may improve their mental health and well-being.

Introduction: The investigation and reporting of medical accidents are important to prevent medical errors and ensure patient safety. A successful reporting system should be non-punitive, meaning that reporters are free from any reprisals that arise owing to their reporting of a medical incident.

Methods: In this study, we reviewed all lawsuits involving reports in Japan's Medical Accident Investigation System, identified using a Japanese database of lawsuits (https://www.westlawjapan.com/). We examined the basic characteristics of medical accident cases and how these reports were cited in judgments in medical malpractice litigation.

Results: A total of 13 cases, including 15 reports, were collected in this study. Two judgments cited two kinds of reports: those conducted in-hospital and reports prepared by the Medical Accident Investigation and Support Center. Twelve reports (80.0%) were provided by the bereaved family, and four reports (26.7%) were entered into evidence as exhibits for the determination of negligence. Nine reports (60.0%) were cited as evidence of negligence; among these, six reports included content establishing negligence among medical professionals. At least three reports provided grounds for the establishment of negligence in the judgment.

Conclusions: We described the basic characteristics of malpractice lawsuits related to the medical accident reporting system established under Japanese law. The current situation of reports provided in medical malpractice lawsuits in Japan indicates discrepancies between their use and the purpose of a non-punitive reporting system. Systems to ensure patient safety should be separate and distinct from those intended to report negligence by medical professionals.

Introduction: Our previous findings indicated that hospitals frequently restrict access to genetic information, while access to other types of sensitive information-such as psychological counseling records or infectious disease diagnoses-is limited in a smaller proportion of facilities (Suzuki et al., 2023). This practice, grounded in a paternalistic medical framework, highlights the need to incorporate patients' perspectives into future information governance. Therefore, this study aimed to explore how individuals with a history of cancer perceive the sensitivity of various types of medical information, as well as their expectations regarding access control and information sharing.

Methods: We conducted a questionnaire survey among 1,079 cancer survivors, using vignette-style hypothetical scenarios to assess their perceptions of medical information sensitivity and preferences for access restrictions in clinical practice. Participants evaluated 13 types of information that had previously been subjected to restricted access in actual hospitals.

Results: Of the participants, 639 (59.2%) believed that some types of medical information are more sensitive than others. Human immunodeficiency virus (HIV) -related information (64.3%) and information on refractory genetic disorders (57.0%) were most frequently identified as requiring strict access control. Genetic information on hereditary tumors was perceived as significantly less sensitive than that on refractory hereditary diseases (p < 0.05). Only a small fraction of participants believed that such restrictions were unnecessary.

Conclusions: These findings suggest that patients' perceptions of sensitivity are closely linked to concerns about psychological, social, and ethical vulnerabilities, and may not directly reflect existing institutional access control practices. Notably, patients perceived HIV-related information as particularly sensitive despite limited institutional restrictions, whereas genetic information, though frequently restricted in hospitals, was not always perceived as equally sensitive. This divergence underscores the importance of incorporating both patient and clinician perspectives to align information governance with actual sensitivity concerns. Future studies involving physicians' perspectives could further elucidate these perceptual disparities and foster more inclusive policymaking in healthcare data management.

Introduction: The increase in peripheral angiotensin II level results in neurogenic hypertension with brain inflammation. Macrophages in the cerebrospinal fluid (CSF) influence neuroinflammation through communication between the peripheral and central nervous systems. However, the role of macrophages in neurogenic hypertension development remains unclear. We hypothesized that macrophages in the CSF have a role in the development of angiotensin II-initiated neurogenic hypertension.

Methods: Sprague-Dawley rats with radio-telemetry pressure transducers underwent surgery for the subcutaneous implantation of either saline- or angiotensin II-filled osmotic minipump. They received an intracerebroventricular injection of either phosphate-buffered saline-liposome as a control or clodronate-liposome to deplete macrophages. Postoperatively, rats received 2% salt diet for 14 days. Different groups of rats underwent a hexamethonium challenge test at 7-9 days after treatment initiation to evaluate their sympathetic tone.

Results: Rats with angiotensin II-salt treatment demonstrated a time-dependent arterial pressure increase. Rats receiving angiotensin II-salt treatment with clodronate-liposome had delayed arterial pressure increases and lower mean arterial pressure (91 ± 4 mmHg) than rats receiving control-liposome (111 ± 4 mmHg) on day 8. The angiotensin II-salt treatment increased the peak depressor response to intravenous hexamethonium injection, messenger RNA expression of interleukin-6 and transforming growth factor-ß, and number of Iba1-positive cells in the brainstem. Intracerebroventricular injection of clodronate-liposome attenuated the angiotensin II-salt-induced increases in the depressor response, gene expressions, and cell number.

Conclusions: Our data suggest that macrophages in the CSF are involved in the development of angiotensin II-salt-induced neurogenic hypertension by modulating brain inflammation.

Introduction: The demand for genetic counseling is increasing in Japan owing to rapid advancements in genetic medicine and increased utilization of genetic testing. However, access to genetic counseling remains limited, particularly in rural areas, owing to a shortage of certified professionals. Online genetic counseling (OGC), a form of telemedicine, offers a potential solution to address these disparities. Although OGC is widely practiced in Western countries, its implementation and systemic evaluation in Japan remain limited. To our knowledge, this study represents the first attempt in Japan to systematically assess the effectiveness, challenges, and user satisfaction of OGC compared with in-person genetic counseling (IPGC) in the context of the Japanese health care system.

Methods: This cross-sectional, single-center study involved 49 participants (15 OGC, 34 IPGC) who received genetic counseling at the NHO Tokyo Medical Center between July 2020 and January 2025. Participants completed anonymous questionnaires assessing demographic characteristics, satisfaction with counseling, and perceived advantages and disadvantages. Statistical analyses included Mann-Whitney U tests, chi-square tests, and Fisher's exact tests. Free-text responses were analyzed using conventional content analysis and word cloud visualization.

Results: Overall satisfaction was high in both groups, with all participants selecting "Strongly agree" or "Agree" regarding satisfaction. However, the IPGC group scored significantly higher in counselor introduction, responsiveness, and overall satisfaction. OGC participants had significantly longer travel times and were more likely to be in their 20s-30s. Key advantages of OGC included convenience and accessibility, whereas disadvantages included concerns about privacy and technical issues.

Conclusions: OGC has high potential to improve access to genetic services in Japan, particularly for individuals in remote areas. Despite high satisfaction, challenges such as communication limitations, privacy concerns, and lack of insurance coverage must be addressed. Policy reforms, improved infrastructure, and further large-scale studies are needed to support the widespread implementation of OGC in Japan.

Introduction: The importance of promoting the autonomy of people with dementia has been globally emphasized. Several studies have investigated factors that impede and facilitate their decision-making. However, few studies have explored these factors in light of their decision-making process. Therefore, this study aimed to determine factors in patient-clinician interactions that influence patient autonomy and participation in decision-making among Japanese patients with dementia.

Methods: The authors adopted qualitative methods to understand the perceptions of health care professionals such as physicians, nurses, physical therapists, care managers, and social workers. Between January and March 2022, individual in-depth interviews were conducted online with 24 health care professionals with ample experience in primary palliative care for dementia. The topics were the support provided in patients' decision-making, the support provided to proxy decision-makers, and the efforts undertaken for building a relationship between patients and families or among multidisciplinary teams. All interviews were audio-recorded electronically and transcribed verbatim. These data were synthesized and analyzed using content analysis.

Results: Four main themes were derived that captured the factors that influence the decision-making process of Japanese patients with dementia in patient-clinician interactions: rapport, decision-making capability, provision of explanation, and presentation of options. The findings highlighted the importance of building rapport with patients through communication in the early stages of dementia, improving patients' decision-making capability and protecting vulnerable patients who cannot make decisions independently, explaining each option's risks and benefits in a comprehensible manner, and presenting a wide range of options to patients in everyday decision-making.

Conclusions: Overall, the themes were in accordance with the process of informed consent. The findings also showed that clinicians must understand the barriers to obtaining informed consent that arise from patients' cognitive impairment, decline, and fluctuations, in addition to cultural factors.

Introduction: Near-infrared photoimmunotherapy (NIR-PIT) has emerged as a promising treatment for unresectable locally advanced or recurrent head and neck cancer. This study aimed to identify potential predictors of NIR-PIT efficacy before treatment by focusing on blood biomarkers in addition to pathological findings, including epidermal growth factor receptor (EGFR) expression in tumors.

Methods: A retrospective analysis of the medical records of 10 patients with head and neck cancer, who exhibited confirmed EGFR expression and underwent NIR-PIT treatment at Akita University Hospital from December 2021 to April 2024, was conducted (13 cycles of NIR-PIT). EGFR expression, cluster of differentiation (CD) 4/CD8 ratio, regulatory T cell (Treg) frequency, serum albumin, neutrophil-to-lymphocyte ratio (NLR), and neutrophil-to-eosinophil ratio (NER) were calculated from the tumor tissue and blood collected immediately before treatment. Correlations of these factors with tumor response to NIR-PIT were determined.

Results: The objective response rate (ORR) was 61.5% and the disease control rate (DCR) was 100%. A statistically significant association was observed between the EGFR index and tumor response. No statistically significant correlation was found between other biomarkers (CD4/CD8 ratio, Treg frequency, serum albumin, NLR, NER) and tumor response.

Conclusions: These findings underscore the important role of EGFR expression in predicting the efficacy of NIR-PIT in the management of head and neck cancer, and highlight the significance of incorporating EGFR assessment in patient selection and optimized treatment strategies. Further studies are needed to elucidate the role that these other potential predictors, including tumor immune response markers, play in NIR-PIT outcomes.

Introduction: This study aimed to investigate the changes in maternal body composition during pregnancy in Japanese women and the relationship between maternal body composition and newborn birth weight using pre-pregnancy body mass index (BMI) in all trimesters.

Methods: A total of 1,851 pregnant Japanese women were enrolled in this study. Body composition was measured using TANITA MC-190EM. The associations between newborn birth weight and maternal BMI, fat mass (FM), fat-free mass (FFM), total body water (TBW), muscle mass (MM), FM gain, FFM gain, and weight gain were evaluated.

Results: The participants' age and pre-pregnancy BMI were 34.1 years and 21.4 kg/m², respectively. Among the patients, 13.4%, 73.0%, 10.3%, and 3.3% were underweight, average weight, overweight, and obese, respectively. The FM showed no significant change from the second to third trimesters in the underweight, overweight, and obese groups. Moreover, the FM in the overweight and obese groups did not change during any period. The FFM, TBW, and MM significantly increased from the first to second and second to third trimesters. In BMI-stratified multivariate regression analyses, FFM in the normal and overweight groups was positively associated with birth weight, whereas FM gain was negatively associated in the underweight and normal groups. No significant associations were observed in the obese group.

Conclusions: Changes in maternal body composition during pregnancy in Japanese women varied by pre-pregnancy BMI. Associations with birth weight also differed by BMI group. Further prospective studies are needed to confirm these relationships and investigate the mechanisms.

Introduction: Polypharmacy is common among hospitalized post-stroke patients and is associated with adverse outcomes, such as decreased physical function and increased risk of drug-related complications. However, the association with functional outcomes, such as activities of daily living (ADLs) and muscle health remains unclear in this population. This study aimed to investigates whether reducing the number of medications during hospitalization is associated with improved ADL and muscle health in post-stroke patients.

Methods: We conducted a retrospective observational study of post-stroke patients with polypharmacy (≥5 medications) undergoing inpatient rehabilitation. Patients were categorized based on whether the number of medications decreased during hospitalization. Outcomes at discharge included the motor domain of the functional independence measure (FIM), handgrip strength, and skeletal muscle mass index (SMI), assessed by bioelectrical impedance analysis. Propensity score (PS) matching and multivariate linear regression was performed to examine associations between medication reduction and each outcome, adjusting for clinically relevant confounders.

Results: A total of 419 patients (mean age 75.9 years; 55.8% male) were included. Medication reduction occurred in 32.5% of patients, with a median decrease of two drugs. After PS matching, the cohort included 212 patients. In the multivariate analysis of this cohort, medication reduction was independently associated with higher FIM-motor scores (β = 0.105, p = 0.006) and greater handgrip strength (β = 0.073, p = 0.043), but were negatively associated with SMI (β = −0.158, p = 0.017).

Conclusions: Medication reduction during hospitalization was associated with improved ADL and muscle strength, but were negatively associated with muscle mass, in post-stroke patients with polypharmacy. Medication optimization may support functional recovery in this population.

Introduction: Preventing skeletal muscle mass loss may improve survival in patients with chronic liver disease (CLD); however, the clinical factors associated with maintaining skeletal muscle mass remain poorly understood.

Methods: Clinically stable patients with CLD who underwent multiple computed tomography scans between March 2004 and April 2023 were enrolled. The annual rate of change in skeletal muscle area (ΔSMA/year) was assessed using a 3-dimensional image analysis system. Muscle mass preservation was defined as ΔSMA/year ≥0. The clinical factors associated with the prevention of muscle mass loss and their association with mortality were assessed using logistic regression analysis and Cox proportional hazards models.

Results: Of the 586 patients (52% men; median age, 67 years; median model for end-stage liver disease score, 9), muscle mass was preserved in 124 (21%). Male sex (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.27-0.73), alcohol-related liver disease (OR, 0.37; 95% CI, 0.18-0.77), and the branched-chain amino acids-to-tyrosine ratio (BTR) (OR, 1.17; 95% CI, 1.03-1.33) were independently associated with preservation of muscle mass. During a median follow-up of 3.7 years, patients with muscle preservation had a higher overall survival rate than those without (log-rank test, P = 0.007), with a hazard ratio (HR) of 0.58 (95% CI, 0.39-0.87). Preservation of muscle mass also independently predicted improved survival (HR, 0.56; 95% CI, 0.32-0.99).

Conclusions: Male sex, alcohol-related liver disease etiology, and BTR are independent factors for muscle mass preservation, which is a significant determinant of survival in patients with CLD.

Introduction: The atopic march describes the progression from early eczema to food allergies and asthma. In Japan, early-onset atopic dermatitis (AD) is linked to allergic diseases, but the role of peanut sensitization-a known asthma risk factor in Western populations-remains uncertain because of its lower prevalence. This study aimed to evaluate whether peanut sensitization predicts asthma development in Japanese children with AD and to compare its predictive value with other common allergens.

Methods: We conducted a retrospective cohort study of 203 children under age two with physician-diagnosed AD who underwent simultaneous measurement of specific immunoglobulin E to egg white, peanut, and house dust mite at a tertiary Allergy Center in Tokyo. Participants were followed until age six. Sensitization was categorized as none, mono (one allergen), or oligo (≥2 allergens). Associations with asthma development were evaluated using multivariate logistic regression and decision tree analysis.

Results: Asthma developed in 32.0% of participants. Peanut sensitization was significantly more common in the asthma group (53.8% vs. 29.7%, p = 0.001), as were oligo-sensitization and allergic rhinitis. Decision tree analysis identified peanut sensitization as the most influential predictor, with an 83% asthma incidence among children with both peanut sensitization and rhinitis. Logistic regression confirmed peanut sensitization as an independent risk factor (adjusted odds ratio: 2.74, 95% confidence interval: 1.44-5.24).

Conclusions: Peanut sensitization in infancy strongly predicts asthma in Japanese children with AD. Early allergen-specific sensitization profiling may help identify high-risk children and support targeted asthma prevention strategies.

Introduction: Balloon-assisted enteroscopy is the gold standard for evaluating small bowel lesions in Crohn's disease (CD); however, its invasiveness and cost limit routine use. Leucine-rich α-2 glycoprotein (LRG) has emerged as a potential noninvasive biomarker. This study aimed to assess the diagnostic utility of LRG compared with conventional biomarkers.

Methods: This retrospective study included 216 patients with CD who underwent balloon-assisted enteroscopy between April 2021 and March 2024. Serum biomarkers, including LRG, C-reactive protein, leukocyte count, neutrophil count, hemoglobin, platelet count, erythrocyte sedimentation rate, and albumin, were analyzed. Endoscopic activity was defined as mucosal ulcers measuring ≥0.5 cm. Diagnostic performance was evaluated using receiver operating characteristic curve analysis, and predictors of endoscopic activity were identified using multivariate logistic regression. Prognostic value was assessed using hospitalization-free and surgery-free survival.

Results: LRG demonstrated the highest diagnostic accuracy (area under the ROC curve (AUC), 0.906), outperforming C-reactive protein ( area under the receiver operating characteristic curve: 0.776). An LRG cutoff of 16.3 μg/mL yielded 72.1% sensitivity and 93.7% specificity. Elevated LRG was independently associated with endoscopic activity (odds ratio: 36.4, p < 0.001) and correlated with higher modified Simple Endoscopic Score for Crohn's disease (mSES-CD). High LRG levels were also predictive of poorer hospitalization-free and surgery-free survival.

Conclusions: LRG is a reliable and non-invasive biomarker for assessing small bowel disease activity in CD, showing superior diagnostic and prognostic performance compared with conventional biomarkers. It may be a valuable adjunct to endoscopic and imaging evaluations in clinical practice.

Introduction: Biological agents have been approved and are now widely used in the treatment of Crohn's disease (CD), fundamentally changing therapeutic strategies. However, evidence regarding long-term outcomes and treatment approaches-particularly in elderly onset (ED) and pediatric onset (PO) CD-remains limited. This study aimed to clarify the long-term prognosis and therapeutic patterns of patients newly diagnosed with CD using a nationwide real-world claims database in Japan.

Methods: A retrospective cohort study was conducted using the DeSC Healthcare Inc. database, identifying 1,345 patients newly diagnosed with CD from 2014 to 2023. Patients were categorized by age at onset as pediatric (<16 years), elderly (≥65 years), and non-elderly/non-pediatric. Treatment strategies were classified as step-up or top-down based on the initial therapy. Kaplan-Meier analysis and log-rank tests were used to evaluate the cumulative rates of advanced therapy-free survival, steroid-free survival, and biological retention.

Results: Of the 1,345 patients, 56 had PO and 472 had EO disease. Top-down therapy was used in 52.2% of cases. The 5-year advanced therapy-free and steroid-free rates were 57.2% and 44.2%, respectively. EO patients showed the highest advanced therapy-free rate (76.2%) and the lowest use of top-down therapy. PO patients had the lowest steroid-free rate and the highest top-down therapy (80%).

Conclusions: Age at CD onset influences treatment strategies in Japan. Early biologic therapy is common in younger patients, whereas conservative approaches are preferred in older adults. Real-world data provide important insights for optimizing individualized CD management in the biological era.

Introduction: Frailty is often considered a pre-disability overall health state. However, even among older adults with disability, assessing frailty can be crucial for providing appropriate support and care services that maintain or promote their remaining independent abilities. The FRAIL-NH scale was developed to assess frailty in nursing home residents and has been shown to be useful in predicting their prognosis. We aimed to determine the prevalence and degree of frailty assessed by the FRAIL-NH scale among nursing home residents in Japan and investigate the associations between frailty status and long-term care (LTC) needs.

Methods: A cross-sectional study was conducted in four nursing homes in the Tokyo metropolitan area of Japan, 2020. Frailty status was assessed using the 7-item FRAIL-NH scale Japanese version: non-frail (0-1 points), frail (2-5 points), and most-frail (6-14 points). Levels of LTC needs at the latest LTC needs certification were obtained from electronic health records. Age- and sex-adjusted multivariable logistic regression analyses were conducted to evaluate the associations between frailty status and the level of LTC needs.

Results: Among 372 residents, 20.7% and 69.9% were frail and most-frail, respectively. Adjusted odds ratios (95% confidence intervals) for being either frail or most-frail were 3.62 (1.31-10.01) and 3.69 (1.14-11.94) for LTC needs levels 4 and 5, respectively, compared to level 3. Similarly, adjusted odds ratios (95% confidence intervals) for most-frail were 3.09 (1.77-5.38) and 6.38 (3.13-13.03) for LTC needs levels 4 and 5, respectively.

Conclusions: Most nursing home residents were assessed as being frail or most-frail. Frailty was strongly associated with LTC needs, indicating important resource implications for care services. Moreover, assessing frailty with the FRAIL-NH scale may support medical and care-related decision-making.

Introduction: This study aimed to examine the predictive factors and timing of delirium onset in hospitalized patients with heart failure, focusing on the impact of total anticholinergic load and other contributing variables.

Methods: The single-site retrospective cohort study included 694 patients hospitalized for heart failure and receiving treatment for hyperpolypharmacy between January 2015 and March 2023. The patients were categorized into delirium and non-delirium groups, with the delirium group further subdivided into early-onset (within 6 days) and late-onset (day 7 or later) subgroups. Logistic regression analyses were performed to identify significant factors associated with delirium onset.

Results: Compared with the non-delirium group, the delirium group (n = 54) showed a higher total anticholinergic load, malnutrition prevalence, and elevated N-terminal pro-brain natriuretic peptide levels. Early-onset delirium was associated with a higher total anticholinergic load and C-reactive protein levels, whereas late-onset delirium correlated with malnutrition. Hyperactive delirium was predominant in the early-onset group and the hypoactive or mixed subtypes in the late-onset.

Conclusions: Elevated anticholinergic loads and the presence of infection were primary contributors to early-onset delirium; malnutrition and the body mass index were critical for late-onset delirium. These findings emphasize the need for targeted preventive strategies based on delirium onset timing.

Introduction: Chlorhexidine mouthwash is one of the most widely used anti-microbial agents, reducing oral cavity bacterial load. However, the effects of mouthwash on systemic conditions in patients with chronic kidney disease (CKD) remain unknown. We examined the relationship between Streptococcus mutans abundance in the oral cavity and proteinuria in patients with CKD.

Methods: Patients with CKD (n = 57) gargled with mouthwash containing chlorhexidine gluconate three times daily for 1 year. We prospectively investigated the relationship between changes in the number of S. mutans and proteinuria.

Results: The number of S. mutans colony-forming units (CFU) ≥10³/mL saliva at month 0 was significantly associated with higher urinary proteinuria and S. mutans CFU/mL over time. The mean number of S. mutans in all patients decreased significantly after 12 months. Proteinuria also decreased significantly after 12 months compared with after 6 months. The rate of proteinuria <0.3 g/g creatinine after 12 months was significantly higher in the group that had <10³ CFU/mL S. mutans after 12 months than in other groups.

Conclusions: In this pilot study, a potential association was observed between oral S. mutans counts and proteinuria in patients with CKD. Larger studies are needed to clarify this relationship.

Introduction: Statins can treat dyslipidemia, but even if low-density lipoprotein decreases to target levels, high triglyceride (TG) levels may represent a residual risk. Therefore, we performed a crossover study comparing pemafibrate and omega-3-acid ethyl esters docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) in patients with untreated hypertriglyceridemia.

Methods: Patients were randomized by the envelope method to pemafibrate or DHA+EPA for 6 months and then switched to the other medication for 6 months. The primary endpoint was TG level, and secondary endpoints were lipid markers, fatty acid 4-fractionation, kidney and liver markers, and the Fibrosis-4 index.

Results: In the 36 analyzed patients, pemafibrate showed a significantly greater decrease in TG (p < 0.001) and remnant-like particles cholesterol (p = 0.001) and a significantly greater increase in high-density lipoprotein (p < 0.001), but DHA+EPA showed a significantly greater improvement in fatty acid 4-fractionation (p < 0.001).

Conclusions: When combined with a statin, pemafibrate appears to have a stronger effect in lowering TG and remnant-like particles cholesterol but DHA+EPA appears to be more effective in terms of fatty acids. Pemafibrate may be an effective first choice for hypertriglyceridemia, and add-on DHA+EPA may be beneficial when pemafibrate is not sufficiently effective. Findings need to be confirmed in larger studies.

Introduction: Older adults with multimorbidity often experience substantial treatment burden, which can compromise their quality of life and adherence to medical treatment. Accordingly, physicians need to prioritize treatment burden. However, physician characteristics associated with prioritization of treatment burden among older adults with multimorbidity in outpatient care remain unclear. This study aimed to: (1) develop a brief, clinician-oriented scale to assess prioritization of treatment burden in outpatient settings and evaluate its reliability and exploratory validity; and (2) examine associations between prioritizing treatment burden and physician attributes in Japan.

Methods: We conducted an anonymous postal survey in June and July 2022 targeting 3,300 physicians affiliated with the Japan Geriatrics Society or the Japan Primary Care Association. Physicians' prioritization of treatment burden was assessed using a newly developed six-item scale. After evaluating the scale's reliability and validity, we dichotomized participants by the median score and used modified Poisson regression to analyze associations between prioritizing treatment burden and physician characteristics (sex, years of experience, and practice setting).

Results: Responses from 688 physicians who provided outpatient care were analyzed. The scale demonstrated good construct validity and internal consistency (Cronbach's alpha = 0.771). Female physicians were significantly more likely to prioritize treatment burden than male physicians (model 1: prevalence ratio [PR] 1.204, 95% confidence interval [CI]: 1.084-1.336; model 2: PR 1.202, 95% CI: 1.082-1.335). No significant associations were found between prioritizing treatment burden and years of clinical experience or practice environment (e.g., facility type, patient age distribution).

Conclusions: The newly developed clinician-oriented scale demonstrated exploratory validity for assessing physicians' prioritization of treatment burden. Furthermore, prioritization of treatment burden was more strongly associated with personal attributes-particularly sex-than with clinical experience or practice setting. These findings underscore the need for educational interventions to enhance physicians' awareness of treatment burden.

Introduction: As the "pharmacy of the world," India plays a critical role in global pharmaceutical supply. However, increasing reports of substandard and falsified medicines raise serious concerns. With Jammu and Kashmir witnessing repeated quality failures of ceftriaxone, this study aims to verify its quality using a refined high-performance liquid chromatography (HPLC) -based analytical method.

Methods: The ceftriaxone assay was performed using Agilent 1260 Infinity HPLC System with a C18 column and EZChromS1 software. A solvent system of acetonitrile and water (20:80, v/v) was used, with flow rate of 0.5 mL/min and ultraviolet detection at 254 nm. Standard solutions (20-70 μg/mL) were prepared from a 1,000 μg/mL stock for calibration. Nineteen injectable ceftriaxone brands were procured and coded for anonymity. Sample solutions were prepared at 50 μg/mL. The method was validated as per International Council for Harmonisation (ICH) guidelines for accuracy, precision, linearity, specificity, limit of detection (LOD), limit of quantification (LOQ), and robustness. Solution stability was assessed over 7 days at 2°C-8°C.

Results: The developed isocratic reversed-phase HPLC method showed good linearity (R² = 0.9991) over the range 20-70 μg/mL, with LOD and LOQ of 5.88 μg/mL and 17.83 μg/mL, respectively. Intra-day and inter-day precision and accuracy showed percentage relative standard deviation (%RSD) values <2% and mean recovery within acceptable limits (96.9%-102.6%). Robustness was confirmed through variations in flow rate, mobile phase composition, detection wavelength, and column temperature, all yielding %RSD <2%. Analysis of 19 marketed formulations revealed that 89.5% complied with pharmacopoeial standards (90.0%-115.0% recovery), while 10.5% (CEF A17, CEF A19) were substandard, indicating significant quality variation among brands (p < 0.05).

Conclusions: A simple, sensitive, and cost-effective HPLC method was developed and validated for estimation of ceftriaxone in pharmaceutical dosage forms. Among 19 tested formulations, 89.5% complied with Indian Pharmacopoeial standards, while two formulations were found substandard, indicating variability in product quality.

Introduction: To clarify whether continuous-monitoring can detect bradycardia during propranolol treatment for infantile hemangioma (IH) and explore management practices for patients with bradycardia.

Methods: This retrospective study with historic controls was conducted on children with IH aged 0-1 year admitted for propranolol treatment at the National Center for Child Health and Development between October 2016 and July 2023. Patients were divided into two groups based on the monitoring method, namely, the spot-measurement group (October 2016 to August 2018) and the continuous-monitoring group (September 2018 to July 2023). Bradycardia was defined as a heart rate of <90/min lasting for 20 minutes. Patient data included clinical characteristics, propranolol dosage, and adverse effects (bradycardia, hypotension, and hypoglycemia). Statistical analyses were performed using Fisher's exact and Mann-Whitney U tests.

Results: During the study period, 106 patients were admitted for propranolol therapy; 49 were in the spot-measurement group and 57 in the continuous-monitoring group. The frequency of bradycardia was significantly higher in the continuous-monitoring group than in the spot-measurement group (21% vs. 2%, p = 0.003). In the continuous-monitoring group, 2 of 12 patients with bradycardia were symptomatic. All patients experienced prompt resolution of symptoms with the reduction of propranolol dosage and had favorable outcomes for IH.

Conclusions: Continuous-monitoring can detect bradycardia more effectively during propranolol treatment for IH than spot-measurement, and reducing the dosage of propranolol can lead to favorable outcomes for IH while minimizing the risk of bradycardia.

Introduction: There is no standard geriatric assessment (GA) for patients aged ≥65 years with lung cancer (hereafter referred to as patients). This retrospective study evaluated whether GA could be achieved by combining Geriatric-8 (G8) score (G8s), body weight loss (BWL) of more than 5% (5%BWL), and bioelectrical impedance analysis (BIA).

Methods: This study included patients who underwent G8 screening, BIA (measuring skeletal muscle mass index [SMI] and extracellular water-to-total body water ratio [ECW/TBW]), and physical function tests before treatment at our hospital between March 1, 2023, and December 31, 2024. Patient clinical records were reviewed to collect baseline data. Statistical analyses were conducted using R (version 4.1.1).

Results: A total of 120 patients were analyzed. We found the following significant associations: G8s ≤14.0 and 5%BWL were associated with advanced-stage disease; G8s >14.0 and SMI ≥cut-off value (CV) with higher body mass index; ECW/TBW ≥0.4 (0.4 ECW/TBW) with aging and poor performance status; 5%BWL with lower maximum lower leg calf circumference (MLLCC); SMI ≥CV with higher maximum handgrip strength (MHGS) and MLLCC; 0.4 ECW/TBW with lower MHGS, gait speed, and five-time sit-to-stand performance. The multivariate analysis confirmed significant associations: G8s ≤14.0 was associated with cancer cachexia; SMI < CV and 0.4 ECW/TBW were associated with sarcopenia, and 0.4 ECW/TBW was associated with physical function decrease, as indicated by a Short Physical Performance Battery score of ≤9. Patients with G8s ≤14.0, 5%BWL, or 0.4 ECW/TBW had shorter survival durations than their respective counterparts. Patients were classified into three frailty categories (none, mild combined with moderate, severe) based on a combination of four factors (G8, BWL, SMI, and ECW/TBW) and had distinct survival curves.

Conclusions: The combination of these four factors offers a simple and objective approach for GA in patients.

Introduction: Robust methodologies for risk stratification remain necessary for gastric cancer (GC). We investigated the prognostic significance of preoperative lactate dehydrogenase (LDH) and two LDH-based indices, the LDH-to-lymphocyte ratio (LLR) and LDH-to-albumin ratio (LAR), in patients undergoing curative resection for GC.

Methods: We retrospectively reviewed the medical records of 225 consecutive patients with GC who underwent R0 surgical resection. The prognostic value of preoperative LDH, LLR, and LAR was assessed using time-dependent receiver operating characteristic curves and Cox proportional hazards regression. Optimal cut-off values were determined with X-tile software.

Results: The median follow-up period was 61 months. The areas under the curves for predicting overall survival (OS) and relapse-free survival (RFS) were notably higher for LLR and LAR as compared to LDH alone. In univariate Cox analyses, both LLR and LAR were significantly associated with OS and RFS, whereas LDH was not. In multivariate analyses, LLR and LAR remained independent predictors of OS (high LLR: hazard ratio [HR] 2.66, 95% confidence interval [CI] 1.34-5.28, p = 0.005; high LAR: HR 2.61, 95% CI 1.45-4.71, p = 0.001). Similarly, both indices retained independent prognostic significance for RFS (high LLR: HR 2.22, 95% CI 1.14-4.31, p = 0.019; high LAR: HR 2.65, 95% CI 1.49-4.72, p < 0.001).

Conclusions: Preoperative LLR and LAR are independent prognostic indicators for OS and RFS in patients with resectable GC. These indices may facilitate early identification of high-risk patients and support individualized treatment strategies.

Introduction: Hypertension is a key risk factor for chronic kidney disease (CKD) progression. While mean blood pressure (BP) is well known to predict kidney outcomes, the role of BP variability (BPV) -especially day-to-day variability measured at home-in CKD remains unclear.

Methods: In this retrospective cohort study of 150 patients with CKD, home systolic BP (SBP) was measured daily for up to 28 days. Mean SBP and day-to-day BPV (standard deviation of daily SBP) were calculated. Associations with the annual estimated glomerular filtration rate (eGFR) slope and a composite kidney endpoint (≥40% eGFR decline, kidney failure, or kidney-related death) were analyzed using linear mixed-effects models and Cox regression. The interaction between mean SBP and BPV on kidney outcomes was also evaluated.

Results: The study population consisted of 150 patients (mean age, 66.1 years; 52% male) with a mean baseline eGFR of 43.2 mL/min/1.73 m². Higher mean SBP was significantly associated with a steeper eGFR decline and increased risk of the composite kidney endpoint. In contrast, BPV was not independently associated with kidney outcomes. However, a significant interaction was observed, indicating that the detrimental effect of elevated mean SBP on kidney progression was amplified in patients with higher BPV.

Conclusions: Mean home SBP was significantly associated with CKD progression. Although BPV alone was not independently related to outcomes, its interaction with mean SBP suggests that BP instability may exacerbate hypertension-related kidney damage. These findings highlight the clinical importance of both lowering and stabilizing BP in CKD management.

Introduction: Malnutrition is common and often goes unrecognized among hospitalized patients, particularly older adults. Early identification and individualized nutritional interventions are essential for improving outcomes. The Nutritional Risk Screening 2002 (NRS-2002) is a validated tool widely used in acute care settings, but its utility in dental and oral surgery remains underexplored. This study aimed to evaluate the clinical utility of NRS-2002 in patients admitted to the Department of Oral and Maxillofacial Surgery (OMFS) at a university-affiliated dental hospital in Japan, and to examine the relationship between nutritional risk and clinical factors such as age, body mass index (BMI), diagnosis, and length of hospital stay.

Methods: A retrospective observational study was conducted on 548 patients (224 men, 324 women) hospitalized between August 2024 and March 2025. Nutritional screening was performed at admission using NRS-2002. Patients scoring ≥3 were classified as at nutritional risk and further assessed according to the Global Leadership Initiative on Malnutrition criteria.

Results: The overall prevalence of nutritional risk, defined as NRS-2002 ≥3, was 1.6% (n = 9), which was insufficient for robust statistical analysis. Most patients identified as at nutritional risk were elderly women with low BMI and severe conditions, including medication-related osteonecrosis of the jaw and osteomyelitis. These patients experienced prolonged hospital stays and were more likely to require oral nutritional supplements. In contrast, the majority of inpatients were younger adults, accounting for the overall low prevalence of nutritional risk.

Conclusions: The NRS-2002 effectively identified older, underweight patients who underwent OMFS with severe conditions and longer hospital stays, despite the overall low prevalence of nutritional risk. Early nutritional screening with standardized tools such as NRS-2002 may help optimize perioperative management.

Introduction: Japanese society is rapidly aging, and increasing numbers of older adults are living alone, which may hinder the early detection and management of dementia. This study aimed to investigate the characteristics of older adults living alone who attended a memory clinic, focusing on cognitive, physical, and caregiving burdens.

Methods: A total of 278 older adults (aged 66-94 years) were categorized as living alone (n = 57) or living with others (n = 221). Evaluations included cognitive, physical, and behavioral assessments, caregiver burden (Zarit Burden Interview-8), and long-term care insurance (LTCI) status.

Results: The group living alone was older and included a higher proportion of women. They had lower cognitive scores on the Montreal Cognitive Assessment-Japanese version and the Raven's Colored Progressive Matrices but showed higher grip strength, Rivermead Mobility Index, and Vitality Index scores. Walking speed, Timed Up and Go Test, and depressive symptoms were similar between groups. Caregivers of those living with others reported greater role strain, while LTCI use was generally low, particularly among participants living alone.

Conclusions: Older adults living alone face a greater risk of cognitive decline despite preserved physical function. Low LTCI utilization highlights the need for enhanced support. Effective strategies should aim to maintain both cognitive and physical function while addressing caregiver needs across different living arrangements.

There is increasing awareness of the need to incorporate social determinants of health (SDH) into medical practice. However, the extent to which the reimbursement system addresses SDH remains unclear. This narrative policy review aimed to evaluate the Japanese medical reimbursement system to determine whether and to what degree it incorporates assessments and actions related to SDH, with a special focus on primary care settings. We also explored the potential impacts and challenges of these programs in addressing patients' SDH issues.

A team consisting of physicians experienced in clinics, hospitals, home care, social epidemiological research, and a community care nurse reviewed the current reimbursement system. They identified eight medical reimbursement programs for evaluation.

Two programs directly included SDH elements ("Hospitalization and Discharge Support Fee" and "Guidance in Cooperation with Mental Health Care Fee"). The two programs were introduced in 2022. It was found that SDH assessments are often optional and need more clarity in their items; few programs offer SDH assessments in outpatient and home care settings, and there is no mandate for collaboration with community supporters.

We found the Japanese reimbursement system has provisions for some programs involving SDH. However, significant challenges remain that require revision. This study offers insights and recommendations for addressing health disparities related to SDH in the future.

On March 28, 2025, a 7.7-magnitude earthquake struck Myanmar, causing severe damage in Bangkok, including the collapse of a high-rise building. This incident revealed the structural vulnerabilities of rapidly urbanizing cities such as Bangkok. First, adopting earthquake-resistant building codes, similar to Japan's "Building Standard Act," is essential in areas with high population density and skyscrapers. Second, Bangkok, as the world's top tourist city, faces challenges in crisis communication due to language barriers. A government-managed mobile application providing multilingual alerts, shelter information, and embassy contacts is proposed to assist foreign visitors. Strengthening both infrastructure and communication systems is critical to improving resilience and protecting residents and tourists during future disasters.

In Japan, active vitamin D has been widely prescribed for osteoporosis due to its regulatory approval, in contrast to international practice where it is not considered standard therapy. However, growing evidence indicates that these agents offer limited efficacy in fracture prevention and may pose significant risks. Mechanistically, active vitamin D increases both serum calcium and phosphate, which, in the absence of bone-forming signals such as growth, fracture healing, or high mechanical loading, may promote ectopic calcification rather than bone strengthening. Osteoporosis, particularly in low-turnover states common in aging or immobilization, is poorly responsive to active vitamin D, as calcium incorporation into bone is physiologically limited. Clinical trials have shown little benefit of vitamin D supplementation in individuals without deficiency, and adverse outcomes such as hypercalcemia, nephrolithiasis, kidney impairment, and vascular calcification have been documented, including a recent case series in patients with severe motor and intellectual disabilities. Despite these concerns, Japanese guidelines continue to list active vitamin D as an effective option, diverging from the recommendations of the European Society for Clinical and Economic Aspects of Osteoporosis and the United States Endocrine Society, which reflect nuanced, evidence-graded recommendations rather than explicit discouragement in primary osteoporosis. The persistence of widespread prescribing in Japan likely reflects historical practices, regulatory frameworks, and economic incentives. Given the aging population and high prevalence of osteoporosis, reconsideration of this approach is warranted. Prescribing should be restricted to clear endocrine indications such as hypoparathyroidism or chronic kidney disease-related secondary hyperparathyroidism. Aligning national practice with international standards, while promoting nutritional vitamin D and other evidence-based therapies, could reduce unnecessary harm and improve healthcare efficiency.

Differences in antibiotic dosing recommendations highlight the tension between maximizing efficacy and ensuring safety. Piperacillin is a striking example, with the Sanford Guide recommending regimens of 13.5-27 g/day based on pharmacokinetic and pharmacodynamic principles aimed at patients who are critically ill, whereas the Japanese package insert advises 2-4 g/day, with a maximum of 16 g/day, reflecting a cautious approach focused on safety in general wards. These divergent strategies reflect distinct philosophies: international guidelines prioritize achieving pharmacokinetic/pharmacodynamic targets to optimize outcomes in patients in intensive care units (ICUs), whereas Japanese labeling emphasizes minimizing adverse events and ecological disruption in broader populations. The clinical consequences of indiscriminate application are significant. High-dose regimens used outside ICU contexts may increase risks of allergy, gastrointestinal disturbance, bone marrow suppression, renal injury, and selection of resistant organisms. Conversely, reliance solely on Japanese recommendations in ICU settings may cause suboptimal exposure and therapeutic failure in severe infections caused by organisms such as Pseudomonas aeruginosa. Awareness of these differences is essential for antimicrobial stewardship. Clinicians should tailor dosing to the clinical context, reserving aggressive regimens for patients who are critically ill or at high risk while maintaining safety-oriented dosing in routine ward practice. By recognizing the underlying philosophies and their intended applications, physicians can avoid inappropriate extrapolation, optimize patient outcomes, and reduce the ecological burden of antibiotic use.

Generative artificial intelligence (GenAI) is now widely used in medicine, including medical writing. Its merits and demerits have been discussed; however, such discussion has not been based on evidence-based medicine (EBM). Here, I focus primarily on GenAI use in medical writing, illustrating how it has already spread before its safety-especially long-term safety-has been confirmed by EBM. I therefore make several modest proposals. Assuming GenAI is a new drug, its use has not yet cleared even the first step of a phase I trial. Assuming it is a new procedure, it remains at the "experience" or "case report" phase. EBM requires the completion of phase I-III trials and randomized controlled trials or meta-analyses before any drug or procedure is confirmed safe and effective. Emergency evacuation can be applied for life-threatening medical conditions; however, it does not apply to "writing." Nevertheless, the current publication world has already gone far beyond: GenAI use is already considerable in medical publication. Thus, three propositions have been made. First, we must recognize that the use of GenAI for writing operates outside the usual EBM framework. Second, we should conduct trials, even if they are difficult and time-consuming, to evaluate the safety and effectiveness of GenAI in writing. Third, we should use GenAI in writing only modestly until safety is confirmed. What is true becomes evident long after, and thus, I believe that we should take a cautious stance toward GenAI use in writing. How cautious should be discussed widely. This viewpoint may contribute to the discussion of GenAI use more generally, beyond medical writing.

Emerging and re-emerging infectious diseases have disproportionately affected marginalized groups such as people with HIV (PWH), yet their specific needs are often overlooked. Drawing on the experience of IMSUT Hospital in Minato ward, central Tokyo-a district that includes Roppongi and Ginza, and serves as a referral center for HIV care-during the COVID-19 pandemic, we highlight how structural factors, stigma, and delayed access to care shaped the impact on PWH. While general medical responses evolved rapidly, HIV-specific vulnerabilities such as vaccine non-responsiveness and prolonged infection persisted. The subsequent mpox outbreak in Tokyo, affecting many PWH, further illustrated how emerging infections in marginalized communities can present with population-specific complications influenced by social and epidemiological contexts. Without such measures, outbreaks among PWH and other vulnerable groups may remain undetected for longer periods and spread more widely, thereby deepening existing disparities.